Autism assessment in Ireland

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Autism assessment in Ireland: Historically autism diagnosis had been the prerogative of GP’s, Psychiatrists and Psychologists who went mostly on their own clinical opinion without using standard instruments. However, it is fair to give some credence to the opinion as it would likely have been based on the DSM/ICD criteria depending on the edition of the day. With early descriptions owing much to Leo Kanner’s work first published in 1944 with his ground-breaking book “Early Infantile Autism”.

If the early clinicians committed this to writing it was a short account of their opinion, that the child appeared to meet the criteria. There was very little in the way of a report with recommendations for any kind of intervention, as the goal was diagnosis and labelling of the child’s condition upon clinical applications.

The use of standard instruments was not widespread in Ireland until 2010-15 onwards, when The Psychological Society of Ireland (PSI) published their first Autism Assessment Guidelines in 2010. It was quite some years until this caught on and became more widespread. The guidelines which were again updated in 2022, proposed that the child/adolescent required multiple components of assessment to include observation, comprehensive child and family history, an account of their adaptive function and cognitive, social and communication ability and function.

Autism Assessment Process in Ireland
Today the process of getting an Autism Assessment in Ireland is a long drawn-out process, whereby children are put on list after list via the public health service route. Reporting symptoms to the GP or health nurse, eventually results in a referral to the regional disability network teams for an assessment of need (AON). Parents and professionals may have to make multiple reports though, to even get on those lists for assessments on children.

By law the AON has to take place within three months, however can take years. Many families have succeeded in court cases against the HSE over these delays that contravene the 2005 disabilities act (https://www.oireachtas.ie/en/debates/qu ... -05-30/50/)

However even getting an AON doesn’t lead to a diagnosis or intervention. The clue is in the title in that this pre assessment process only determines what actual assessments the child needs. So, in effect the AON is an assessment about getting an assessment. After the AON determines the child needs, they are put on the next list for a full assessment. This takes on average 3-7 years in Ireland https://www.irishexaminer.com/news/arid-40313627.html

When the assessment finally takes place this involves hours and hours of form filling and face to face meetings that takes months to complete. Overwhelmingly the feedback from parents who have been through this process report that unless the child ticks every box, at every stage, there will be no diagnosis and even less intervention at the end of it. Early intervention is key for the educational and development of children, and autism assessments in Ireland are far from ideal for young children and vulnerable families (many parents are left unsupported).

If there is a diagnosis the child will then go on other lists for the intervention they need, which again can be years long. Getting any kind of speech and language and occupational therapy intervention sessions involves another long list. Overall, the public system has an overly complex, long assessment process, with little or no intervention at the end of it. Not surprisingly parents often seek private assessment (private clients for their own children!) not to miss time-sensitive windows of opportunity to intervene in their child’s development (www.waterfordpsychology.com)